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Snoring

Medicine > Respiratory

Differential Diagnosis Schema 🧠

Anatomical Causes

  • Nasal obstruction: Deviated septum, nasal polyps, chronic rhinitis leading to narrowed nasal airways.
  • Enlarged tonsils or adenoids: Common in children, causing airway obstruction and snoring.
  • Obesity: Excess fat around the neck and throat causing airway narrowing, leading to snoring.
  • Retrognathia or micrognathia: Receding chin or small jaw leading to reduced airway space.

Functional Causes

  • Alcohol consumption: Relaxes throat muscles, increasing the likelihood of airway collapse during sleep.
  • Sedative use: Similar to alcohol, sedatives relax the upper airway muscles.
  • Sleep position: Supine position encourages tongue and soft palate to fall back, leading to airway obstruction.
  • Hypothyroidism: May cause myopathy of the upper airway muscles, contributing to snoring.

Sleep-Related Breathing Disorders

  • Obstructive Sleep Apnoea (OSA): Loud snoring with episodes of witnessed apnoea, excessive daytime sleepiness, associated with obesity.
  • Upper Airway Resistance Syndrome (UARS): Similar to OSA but without complete apnoeic episodes, leads to disrupted sleep and snoring.

Key Points in History 🥼

Onset and Duration

  • Recent onset: May suggest acute causes such as upper respiratory tract infection or use of sedatives.
  • Chronic snoring: More likely associated with anatomical or long-standing functional causes like obesity or chronic nasal obstruction.

Symptoms and Associated Features

  • Witnessed apnoeas: Suggestive of obstructive sleep apnoea.
  • Excessive daytime sleepiness: Consider OSA or other sleep-related breathing disorders.
  • Morning headaches: May indicate poor oxygenation during sleep, often seen in OSA.
  • Sleep position: Snoring predominantly in the supine position suggests positional snoring or airway collapse.
  • Recent weight gain: May increase risk of snoring due to fat deposition around the neck.

Background

  • Past Medical History: Hypertension, hypothyroidism, or other conditions that may predispose to snoring or OSA.
  • Drug History: Use of alcohol, sedatives, or other medications that relax the upper airway.
  • Family History: Snoring or sleep apnoea in family members, as OSA can have a genetic component.
  • Social History: Alcohol consumption patterns, smoking history, and occupational factors that may affect sleep.

Possible Investigations 🌡️

Sleep Study (Polysomnography)

  • Indicated for suspected OSA or significant snoring with associated symptoms.
  • Monitors breathing patterns, oxygen levels, and identifies apnoeic episodes.
  • Helps to differentiate between simple snoring and OSA.

ENT Examination and Imaging

  • Nasal endoscopy: To assess for nasal obstruction, polyps, or deviated septum.
  • Lateral cephalometry: An X-ray to assess for anatomical causes such as retrognathia or enlarged adenoids.
  • MRI or CT scan: For detailed anatomical assessment if surgical intervention is considered.

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Respiratory